Long Term Stability of Skeletal Class II Treatment with Modified Bionator Followed by Fixed Appliance - A Case Report

The most prevalent malocclusion seen in day-to-day practice is Class II division 1 malocclusion. Most patients with malocclusions in class II division 1 have an underlying skeletal difference between the maxilla and the mandible. The treatment of skeletal class II division 1 depends on the patient's age, the ability of growth potential, the seriousness of malocclusion, and the patient's adherence to treatment. Myofunctional equipment can be successfully used to treat rising patients with deficient mandible class II division 1 malocclusion. This case report shows a focus on Class II Division 1 care due to mandibular deficiency using modified bionator appliances accompanied by fixed mechanotherapy with growth modification approach. Class II Division 1 is one of the most widely encountered form of malocclusion in human populations. The common characteristic of Class II Div 1 malocclusion in growing children is mandibular retrusion, according to Dr. James McNamara.1 The prevalence of Skeletal Class II malocclusion is 15 % of the world's total population. Underlying difference between Maxillary & Mandibular jaw makes the Class II Div 1 malocclusion more complex than it appears. It’s due to a contribution of only maxilla, or only mandible, or a combination of both. The treatment of Class II division 1 relies on the patient's age, growth ability, degree of malocclusion, and patient compliance with therapy.1,2 The cases with retrognathic mandible must be addressed by altering the direction & amount of mandibular growth by using functional appliances.3 The Bionator is a tooth-borne appliance that significantly changes dental and skeletal component of the face through a repositioning of mandible in a more protrusive & balanced way, selective eruption of teeth and profile enhancement.4-7 The Balters Bionator was first introduced in 1960 by Wilhelm Balters as a functional appliance & still one of the most widely used removable appliances for correction of mandibular retrognathism.8 In functional orthopaedics, all aspects of genetically determined individual growth patterns are important, most particularly time, potential, and growth direction. Although during the prepubertal phase there is limited skeletal development, substantial growth occurs during puberty, but with great individual variation. To prevent damage to erupting teeth and to normalize jaw growth, early functional orthopaedic intervention in the prepubertal phase is used.9,10,11 The purpose of this case report is to illustrate how satisfactory results were obtained in the treatment of Class II division 1 malocclusion with modified Bionator in young patients. The positive facial, dental and cephalometric improvements are also illustrated, with the aid of proper diagnosis, amplified by excellent patient cooperation in case selection.